Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Iiv3 vaccine splt 0.5 ml im
Low
$8
Average
$48
Median
$30
High
$238
Each hospital's average Medica rate, under the methodology and billing class chosen below.
56 hospitals; the 90th percentile is 5.9× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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78 hospital rates
iThe hospitals that file a Medica rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Altru Hospital Grand Forks, ND facility · fee schedule · outpatient | 4 | $10 | $13 | $6 | 47% | — | $7 – $22 |
| 2 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 4 | $10 | $13 | $6 | 47% | — | $7 – $22 |
| 3 | Avera Behavioral Health Hospital Sioux Falls, SD fee schedule · outpatient | 2 | $238 | $238 | — | — | — | $238 – $238 |
| 4 | Avera McKennan Hospital Sioux Falls, SD fee schedule · outpatient | 2 | $238 | $238 | — | — | — | $238 – $238 |
| 5 | Avera Specialty Hospital Sioux Falls, SD fee schedule · outpatient | 2 | $238 | $238 | — | — | — | $238 – $238 |
| 6 | Avera St. Luke's Aberdeen, SD fee schedule · outpatient | 2 | $238 | $238 | — | — | — | $238 – $238 |
| 7 | Avera St. Luke's Aberdeen, SD percent of total billed charges · inpatientfrom % of charges | 2 | $42 | $42 | $3 | 8% | — | $39 – $46 |
| 8 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE fee schedule · outpatient | 3 | $32 | $26 | $12 | 47% | — | $5 – $34 |
| 9 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE other · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 10 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE percent of total billed charges · outpatientfrom % of charges | 2 | $3 | $3 | $0 | 6% | — | $3 – $3 |
| 11 | Bowdle Healthcare Center Bowdle, SD fee schedule · outpatient | 2 | $238 | $238 | — | — | — | $238 – $238 |
| 12 | Bowdle Healthcare Center Bowdle, SD percent of total billed charges · inpatientfrom % of charges | 2 | $25 | $25 | $2 | 9% | — | $23 – $27 |
| 13 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 14 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 15 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $30 | $30 | — | — | — | $30 – $30 |
| 16 | Central Iowa Hospital Corporation Des Moines, IA percent of total billed charges · outpatientfrom % of charges | 1 | $10 | $10 | $1 | 6% | — | $9 – $11 |
| 17 | Central Iowa Hospital Corporation West Des Moines, IA percent of total billed charges · outpatientfrom % of charges | 1 | $8 | $8 | $0 | 6% | — | $7 – $8 |
| 18 | Covenant Medical Center Inc Waterloo, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 19 | Curators of the University of Missouri Jefferson City, MO facility · fee schedule · outpatient | 1 | $32 | $32 | — | — | — | $32 – $32 |
| 20 | Essentia Health Ada 201 9th St W Ada, MN facility · percent of total billed charges · inpatientfrom % of charges | 5 | $73 | $72 | $8 | 11% | — | $55 – $79 |
| 21 | Essentia Health Ada 201 9th St W Ada, MN facility · percent of total billed charges · outpatientfrom % of charges | 6 | $73 | $60 | $17 | 29% | — | $35 – $79 |
| 22 | Essentia Health Deer River 115 10th Ave NE Deer River, MN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $38 | $38 | — | — | — | $38 – $38 |
| 23 | Essentia Health Duluth Duluth, MN facility · percent of total billed charges · outpatientfrom % of charges | 4 | $50 | $47 | $9 | 19% | — | $30 – $55 |
| 24 | Essentia Health Fosston 900 Hilligoss Blvd SE Fosston, MN facility · percent of total billed charges · inpatientfrom % of charges | 5 | $73 | $72 | $8 | 11% | — | $55 – $79 |
| 25 | Essentia Health Fosston 900 Hilligoss Blvd SE Fosston, MN facility · percent of total billed charges · outpatientfrom % of charges | 6 | $73 | $60 | $17 | 28% | — | $35 – $79 |
← Payers reporting CPT 90658 · Snapshot 20261112T181611Z-3fa9fb76